NPI 1619203551 · live from the CMS NPI Registry
Jerry R Clark, DDS, MS
Dentist, Orthodontics and Dentofacial Orthopedics in Greensboro, NC. National Provider Identifier 1619203551, active.
NPI record
| NPI | 1619203551 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dentist, Orthodontics and Dentofacial Orthopedics 1223X0400X |
| Practice location | 1115 W Friendly Ave, Greensboro, NC 27401 |
| Practice phone | 336-273-2528 |
| Enumerated | October 28, 2009 |
| Last updated | October 28, 2009 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist, Orthodontics and Dentofacial Orthopedics primary | 1223X0400X | 3338 (PA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.